September 1998

Conspiracy Theories

By Michael J. Katin, MD

We may not be heading into the last days, but we are definitely seeing the gravy train roll away, to be replaced
by the honey wagon. This is a national and probably also an international phenomenon, but, unfortunately, seems
particularly pronounced in the case of the socioeconomic standing of radiation oncology. Those who have not been
living in a cave for the last ten years know that our specialty has been set upon for conquest by hospital chains,
faceless coporate conglomerates, and even by other specialties (e.g., joint venture schemes). None of these quite
succeeded, and the logical next move was devaluation of our services. This would include competition with the null
alternative (supportive care) and decreasing of reimbursement (the HCFA practice expense miscalculations). It would
seem that there has to be a conspiratorial linkage among all these developments. It is also illogical that radiation
oncology is being targeted since there are far more lucractive businesses to go after (pet foods, carpet cleaning,
aluminum siding, etc.).

I would propose that it is time for the leaders of our specialty to appoint a special investigative panel to
determine the source of this concerted effort to destroy radiation oncology. This would allow us to focus our attention
on the real enemy instead of becoming frustrated by blaming market forces, misguided social engineers, or random
capitalist gunslingers. For example, we now know that all international terrorism is directed by Osama Bin Laden,
a previously unknown Muslim millionaire living in any of several countries but obviously not well known enough
to be apprehended. He is also known to be responsible for the sinking of the Lusitania in 1915 and for Stella losing
her groove. I can certainly imagine this insatiable demagogue deciding to throw in the destruction of the practice
of radiation oncology as one of his goals, just to demonstrate his power. Nothing else makes any sense.

It can only be hoped that his vendetta is based on whim rather than a personal need for revenge. It would be
disastrous to learn that a close family member had developed osteoradionecrosis, been plagued by radiation cystitis,
or billed above assignment levels. If, in fact, this is not a personal matter, perhaps appeasement can be achieved,
either with money or services, and possibly by convincing him to substitute another specialty for his wrath Suggestions
will be entertained. The winning specialty will be notified by letter bomb.